MEDICARE: ADVANCED GASTRO & LIVER CARE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0008X	Hepatology Physician	ME68156	FL
2	207RG0100X	Gastroenterology Physician	ME68156	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	34875	OTHER	BCBS - GROUP #
2	34875	OTHER	MCR - GROUP #
3	268039400	OTHER	MCD
4	DA8281	OTHER	MCR RR

General Provider Information

NPI Number	:	1003880279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED GASTRO & LIVER CARE PA

Provider Business Mailing Address
First Line	:	PO BOX 20267
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33622-0267
Country	:	US
Telephone Number	:	727-823-2188
Fax Number	:	727-828-0823

Provider Business Practice Location Address
First Line	:	6225 66TH ST N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-5025
Country	:	US
Telephone Number	:	727-521-0994
Fax Number	:	727-522-2671

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TEJUNDER S GLAMOUR
Credential	:	MD
Telephone Number	:	727-521-0994

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	02/23/2010

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Directions to “ADVANCED GASTRO & LIVER CARE PA ” Practice Location

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